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Publications

Case Reports Journal Article Ppublish

PubMed: 39816020 DOI: 10.21037/jgo-24-359

Balancing anticancer therapy efficacy and safety in advanced hepatocellular carcinoma: a case report.

J Gastrointest Oncol 15(6):2712-2720

Authors: Mohamad Mourad, Layal Al Mahmasani, Noura Abbas, Panot Sainamthip, Berenice Freile, Anas Zayed, Reem Alsuwailem, Osama Khatib, Sara Sinno, Fouad Sabatin, Jinru Shia, Firas Kreidieh, Viktoriya Paroder, Samir Alam, Ali Shamseddine, Ghassan K Abou-Alfa

Affiliations

  • American University of Beirut Medical Center, Beirut, Lebanon.
  • Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Chulalongkorn University, Bangkok, Thailand.
  • Alexander Fleming Institute, Buenos Aires, Argentina.
  • King Hussein Cancer Center, Amman, Jordan.
  • King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
  • King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
  • Weill Medical College at Cornell University, New York, NY, USA.
  • Trinity College Dublin, Dublin, Ireland.

Abstract

Background

Hepatocellular carcinoma (HCC) is a significant health problem associated with several risk factors, increasingly driven by non-alcoholic steatohepatitis and metabolic syndrome. This association poses a challenge for the primary treatments of HCC, which may include immune checkpoint inhibitors and vascular endothelial growth factor inhibitors, due to their potential cardiotoxic effect. Therefore, it is imperative to balance the therapeutic effects of these agents with their potential cardiovascular adverse events.

Case Description

We describe the case of a man in his seventies with advanced HCC and significant cardiovascular comorbidities who was treated with atezolizumab and bevacizumab. Despite achieving a clinical and radiologic complete response, the patient experienced a deterioration in cardiac function after 16 months, necessitating the discontinuation of bevacizumab. The patient continued to respond well to atezolizumab, but unfortunately, he passed away due to a cardiac event after 4 years of follow-up.

Conclusions

Careful risk stratification and optimization of modifiable risk factors is of uttermost importance in management of HCC. Close monitoring, comprehensive patient management in a cardio-oncology clinic is also vital, particularly for patients at high risk of developing cardiovascular adverse events. The delicate balance between the efficacy of cancer treatments and their potential cardiotoxicity is one of the principal determinants of outcomes of patients diagnosed with HCC.

MeSH

Carcinoma, Hepatocellular, Safety, Bevacizumab, Drug-Related Side Effects And Adverse Reactions, Risk Factors, Therapeutics